Monday, April 30, 2007

Getting Brain-Injured Troops the Best Care

From The Saratogian:

April 29, 2007 -- Sgt. Ken Comstock, a 1999 graduate of Ballston Spa High School who went to Iraq with the National Guard, suffered more than 500 skull fractures in August 2004 when a roadside bomb exploded as he was returning from patrol in a Humvee.Sgt. Comstock thankfully survived, but required extensive treatment abroad, and in the U.S. an estimated 1,600 veterans have required treatment through the nation's Veterans Affairs services for traumatic brain injuries and other severe wounds received while serving in Iraq and Afghanistan.

There is no easy, quick or cheap solution. But two U.S. senators, New York's Hillary Clinton and Indiana's Evan Bayh, have proposed what even they concede would be only a temporary solution to the problem. Their legislation would let soldiers with traumatic brain injury extend their active duty status for a year after suffering the injury....

Keeping them on active duty status would not send the soldiers back into combat, but it would enable them to continue receiving the best medical care for their injuries that the military can provide -- "from the Defense Department and from specialized private care centers, which would be better than care from the Department of Veterans Affairs."

As we all know, TBI is not something one recovers from overnight, so let's support this bill as a good first step.

Thursday, April 26, 2007

Treating TBI With Hormones?

David Wright, MD, Emergency Physician: "Traumatic brain injury is a very significant problem in this country - over 1.2 million head injuries a year."

For ER doctors, it's frustrating.

David Wright, MD, Emergency Physician: "There have been over 100 studies looking for neuro-protectants, for drugs that would help patients after a head injury and absolutely none have been found in over 30 years of research."

That's why Dr. David Wright welcomed the chance to study the natural hormone -- progesterone. The first human studies with 100 patients looked at the safety of injecting the hormone right after an injury. The results were surprising.

David Wright, MD: "There was a 50-percent reduction in mortality, which was the thing that stood out, obviously, the most."

Army's New Equipment May Detect Brain Injury

FORT CARSON, Colo. — The Army, faced with thousands of cases of brain injury from the Iraq war, will soon begin testing brain-scanning equipment in hopes of finding a more accurate way to identify hard-to-diagnose wounds...

To date, the Army has not extensively used neuroimaging equipment to detect brain injuries in returning soldiers because not enough testing has been done to judge the

Monday, April 23, 2007

By Any Other Name...

I love the CBS television show Without a Trace. There's the dramatic tension you might expect from a one-hour program about a search for a different missing person every week. But the writing is superb, the acting exceptional, and, as my wife could tell you, I often end up sniffling by the time the hour is up. Alas, this season, since they moved the show to Sunday nights -- where its airtime is frequently, unpredictably bumped by sports events -- I don't see it much anymore.

But I did for some reason catch the episode ("Crash and Burn") originally aired last Sunday, April 15. (Trailer here, on the ever-valuable YouTube.)

I won't detail the plot here, spoiling it for any of you who'd like to see it. But I can tell you that the plot hinged on a brain injury suffered by a veteran of the US Marines -- not in combat, but in a trail-bike accident.

Two items of interest about this episode:

First, the storyline depended not just on the facts of the veteran's brain injury, but on what life was like for him afterwards. For instance, he recounted one particularly excruciating incident: He'd left his house to walk a couple of blocks to a store one night. When he came out of the store, he looked down the street to his house... and he didn't recognize it.

Second, nowhere in the episode -- that I caught, anyway -- did the phrase "traumatic brain injury" appear (nor, of course, the abbreviation "TBI"). As Jack Sisson says in chapter 1 of his book here at sossisson.com:

I believe one reason traumatic brain injury is not more widely recognized is that it has no name, or rather, too many names. Think about it – concussion, closed head injury, coma, shaken baby syndrome, diffuse axonal injury, second impact syndrome, coup countrecoup injury, contusion -- all refer to brain injury and are often used interchangeably with TBI...

Acquired brain injuries (ABIs) further complicate matters... many experts and organizations refer to all brain injuries as ABIs, with TBI being just one type of ABI. Confused? You should be.

It can be surprising to find TBI referenced in popular culture. More, it can be astonishing to find it referenced as TBI; I kind of wish one of my favorite show's writers had latched onto the term.

If you're interested in the episode, again, the episode title is "Crash and Burn." It will no doubt be re-broadcast sometime between now and the start of next season; you might also watch for it on the TNT cable channel, which shows Without a Trace reruns.

Sunday, April 22, 2007

Kids with Head Injury More Likely to Have Another

Reuters last week reported that children who suffer a head injury are quite likely to have a similar injury subsequently.

"We do not really understand the mechanism behind repetitive head injuries in children," Dr. Bonnie R. Swaine, of the University of Montreal, Canada, told Reuters Health. "These results support anecdotal evidence of the phenomenon."

As for an explanation, Swaine continued, "It is reasonable that children with a head injury who do not regain their pre-injury state of health could be at risk for another injury."

Sunday, April 15, 2007

Commission Hopes to Remove Obstacles to Veterans' Care

The government is finally beginning to address the myriad problems faced by our returning wounded troops, including those with TBI. Found this at PostStar.com:

WASHINGTON - Injured soldiers returning home for medical treatment face an unacceptable maze of paperwork and bureaucracy, leaders of a presidential commission on veterans' health care said Saturday.

At its first public meeting, the nine-member panel heard from veterans, spouses and advocacy groups who decried what they said was a failed system. The commission pledged to work quickly to find solutions rather than assign blame.

"This is not going to be a witch hunt," said former GOP Sen. Bob Dole of Kansas, one of the heads of the Commission on Care for America's Returning Wounded Warriors.

Dole said the commission planned to build upon the work of at least nine congressional committees and other government panels that are investigating veterans' health care problems. Those inquiries followed disclosures in February of squalid conditions and poor outpatient treatment at Walter Reed Army Medical Center in Washington.

Their reviews in recent weeks have pointed to inadequacies with the treatment of brain injury and post-traumatic stress disorder, as well as outpatient care.

Friday, April 13, 2007

TBI Legislation and "Patient's Advocates"

That's what a member of the armed services recovering at Walter Reed Army Medical Center said when Sen. Hillary Clinton, D-N.Y., asked him how he was doing last week.

Clinton recounted the story Wednesday on a conference call with journalists to announce new legislation aimed at helping victims of traumatic brain injury.

The legislation, sponsored by Clinton and Sen. Evan Bayh, D-Ind., would allow TBI victims to extend their "active duty" status for up to one year from the date that their injury is determined.

Brain Injuries Plague Veterans

"We are not addressing the unique challenges posed by TBI in the way that we need to be," Clinton said.

Under the current system, those recovering from TBI are forced to choose between remaining on active duty and receiving the best state-of-the-art care from the Department of Defense or entering retired status and returning to their hometowns to receive care under the umbrella of the Department of Veterans Affairs.

Patient's Advocate for Victims

The bill would also provide that every TBI victim be given a "patient's advocate" to help the patient wade through what can be an enormously complicated and frustrating system.

All of this is very good news, of course, but a "patient's advocate" is a big step forward and a subject dear to Jack's heart. He believes that if he'd been given a "caretaker / advocate / physiatrist / case manager" -- whatever you want to call it -- his care and recovery during those first couple of years would have been much improved. Jack strongly believes this is necessary for all TBI patients.

Thursday, April 12, 2007

Public Needs to Know That TBI is Still the Signature Wound of Iraq War

The following seems a little "after the fact," because Traumatic Brain Injury was labeled the signature wound of the Iraq War last year. Still, even if the military has been slow to fully address this issue, the following AP article from the "Boston Herald" sounds promising (except for identifying TBI as "military parlance"):

AUGUSTA, Maine - Traumatic brain injuries are common among wounded soldiers returning from Iraq, but they’re also commonly misdiagnosed or undetected, according veterans’ activists and Maine’s congressional delegation.

For some soldiers, the injury is graphically obvious.

”They’re the ones with part of their skull missing,” Ron Brodeur, state inspector for the Maine Department of Disabled American Veterans, said during a forum Wednesday on soldiers’ health care.

For others, the traumatic brain injury, or TBI in military parlance, presents itself in subtle ways, said Jack Sims, director of the Togus Veterans Administration Medical Center.

”Our providers are now aware of TBI and are on the lookout for it. We’re trying to be much more proactive in recognizing these things than we were in past conflicts,” he said.

WASHINGTON -- Sens. Evan Bayh and Hillary Rodham Clinton said Wednesday that soldiers with traumatic brain injuries should get extended treatment through the Defense Department instead of the Veterans Affairs Department, which they argued is less capable of handling such injuries.

The Democrats, who serve on the Senate Armed Services Committee, said they would pursue legislation to make that change."The VA does a great job," Bayh said. "But they've simply been overwhelmed by the number of these types of injuries and are still in transition in terms of how best to treat them.

Wednesday, April 11, 2007

New Study Challenges Conventional TBI Treatment

From UCLA Healthcare:

The chemical lactate has gotten a bad rap. Conventional wisdom considered it to be little more than the bane of runners and other athletes, causing stiff muscles and fatigue, and the "sour" in sour milk.

It turns out that view may have been too narrow.

Neuroscientists at UCLA are now looking at lactate with a much more positive eye, considering it a possible replacement "fuel" for the brain in the immediate hours after a traumatic brain injury instead of glucose, the current standard. If they are right, it could change how emergency room physicians and intensive care physicians treat patients with brain injuries in the first critical hours after injury.

Sunday, April 08, 2007

Mild TBI Linked to Sleep Disorders

Anyone who's read this blog for a while is probably aware that Jack's TBI (in the late 80's) caused numerous other conditions, including sleep apnea. That's why his TBI blog sometimes cover seemingly non-related topics. It's like two degrees of separation around here -- they're all related through Jack.

Here's some news on head injuries and sleep disorders:

Science Daily — A mild head injury can increase your chance of developing a sleep disorder, according to a study published in the April 3, 2007, issue of Neurology®, the scientific journal of the American Academy of Neurology. Researchers say these findings highlight the need for improved diagnosis and treatment of sleep disorders in mild traumatic brain injury patients who complain of insomnia.

"As many as 40 to 65 percent of people with mild traumatic brain injury complain of insomnia," said study author Liat Ayalon, PhD, with the University of California, San Diego. "This is concerning since sleeping problems may exacerbate other brain injury symptoms such as headache, emotional distress, and cognitive impairment, making the rehabilitation process much harder."

Monday, April 02, 2007

Gene Linked to Increased Risk of Stroke

One of the most common genetic defects passed on through families significantly increases a person's chance of having a stroke, according to a study published in the Neurology, March 27, 2007.

"This type of gene has previously been associated with brain diseases such as Alzheimer disease, Parkinson disease, ALS, multiple sclerosis, and cerebrovascular disease, but this is the first time we've been able to determine this gene predicts such a significant increased risk of stroke," said study author Borge G. Nordestgaard, MD, DMSc, with Herlev University Hospital in Copenhagen, Denmark.